Cameron Solnordal says medication for schizophrenia, the complex mental health condition he lives with, can be a burden.
A supporter of mental health organization SANE, Solnordal told SBS news that the side effects of antipsychotic drugs and the weight gain they often cause can be life-threatening and prevent people from taking them.
Solnordal says that when he started taking medication for schizophrenia twenty years ago, he gained 40kg in the first few years.
“When you’re learning about how medications affect you, and if you’re a new patient, you’re going to carry that burden because as well as feeling tired, you’re really tired, you’re eating all the time. and just part of the coping mechanism,” he said.
“It has a huge impact on dating. When people say they don’t want to take it, it’s because they hate the way they feel – that’s the number one reason.”
Recently, a new drug was approved for the treatment of schizophrenia by the United States Food and Drug Administration (FDA). It is the first time in more than 70 years that a new class of medicine has been approved for the treatment of this condition.
Cobenfy (originally called KarXT) is a combination therapy of two different drugs: xanomeline and trospium.
This drug targets a different set of receptors in the brain than existing antipsychotic drugs used to treat schizophrenia.
Although modern drugs work on the brain’s dopamine system, Cobenfy focuses on the cholinergic system, which plays an important role in memory, digestion, heart rate, blood pressure and movement.
Professor Ashley Bush, a researcher at the Florey Institute of Neuroscience and Mental Health in Melbourne, told SBS News she was “very pleased” with the FDA’s decision to approve Cobenfy.
“I think it gives hope. The psychiatric community is cautiously optimistic that this might be a new asset to add to the resources for schizophrenia. I think it gives hope for the patient and the psychiatrist,” he said.
What is schizophrenia?
Schizophrenia is a complex mental health condition that affects around 1% of the population, around 200,000 people in Australia and around 24 million people worldwide.
It is characterized by delusions, hallucinations, disorganized speech and behavior and catatonic behavior (lack of response to the environment or people).
Schizophrenia symptoms are often divided into positive symptoms, which include hallucinations or delusions, and negative symptoms, which include decreased mood and social withdrawal.
What medications are used to treat schizophrenia?
There are currently two types of medications used to treat schizophrenia, including “typical” antipsychotics, which were the first generation of schizophrenia medications developed in the 1950s, and “atypical” ” antipsychotics, which were introduced in the 1990s.
Common antipsychotics include drugs such as Chlorpromazine, which was the first antipsychotic drug to be formulated with compounds used to treat epilepsy and sedation.
Atypical antipsychotics include medications such as Clozapine and Risperidone.
However, the side effects of these drugs can be extensive and debilitating. Antipsychotics have been shown to cause weight gain, type 2 diabetes, elevated cholesterol, life-threatening constipation, and a decrease in white blood cells.
Arthur Christopoulos, lecturer in the department of Pharmacy and Pharmaceutical Sciences at Monash University, told SBS News that existing antipsychotics are “dirty drugs” because they target a large number of receptors and cause many side effects.
“[Cobenfy] he said, “It’s more targeted medicine.”
Where is Cobenfy from?
Christopoulos said the journey to get Cobenfy approved began nearly three decades ago after pharmaceutical researchers discovered molecules that could selectively target receptors known as important to control the neurological effects associated with Alzheimer’s disease and schizophrenia.
The drug xanomeline was tested on Alzheimer’s patients but the trials failed due to serious side effects. However, they showed that the drug significantly reduced the symptoms of psychosis.
Later, xanomeline was combined with trospium to reduce unwanted side effects and this combination became the drug that is now approved as Cobenfy.
Christopoulos and other Monash University researchers were involved in a global study to develop this drug.
Christopoulos said Cobenfy could be considered an “add-on” to current antipsychotic drugs and could be used alongside them.
“Targeting this receptor system, it’s a game changer,” he said.
Although the trials that led to its approval in the US were only five weeks long, the FDA said that patients who received Cobenfy “experienced a significant reduction in symptoms” compared to the placebo group.
Providing information for the drug warns that it can cause urinary retention, increased heart rate, and decreased bowel movement, and is not recommended for patients with liver failure.
Christopoulos said that while it may not be a “panacea” it offers a completely different option for medicine.
“It will have a huge impact on the lives of people with schizophrenia in Australia and internationally,” he said.
“If I had to choose, I would rather take this drug than the existing antipsychotics.”
Christopoulos said it was too early to say whether the drug would help treat what is known as ‘schizophrenia-resistant schizophrenia’, where people continue to have symptoms despite taking antipsychotic drugs.
Treatment-resistant schizophrenia affects about a third of people diagnosed with the disease.
When will it be available in Australia?
Christopoulos said it was unclear when Cobenfy would be approved by Australia’s Therapeutic Goods Administration (TGA) but said “it will happen”.
He said there were fast-tracks to TGA approval but it was uncertain whether they would be used.
A spokesperson for the TGA told SBS News that it had not yet received an application to register Cobenfy on the Australian Register of Therapeutic Goods.
“The TGA is aware that the United States Food and Drug Administration has approved Cobenfy. If the TGA approves the application, it is important to note that the TGA will review all the information independently and make its decision based on the Australian standards,” they said. .
Christopoulos also said that, without the Pharmaceutical Benefits Scheme, the drug could be too expensive for some people.
As for Australians living with schizophrenia, Solnordal said many people could be relieved by the arrival of a new medication option.
“If someone sat down and said ‘Let’s try to do something better with schizophrenia and treatment’ then of course people will hang their heads and say ‘finally!’
“It’s such a do-it-yourself approach with what we’ve got … we’re just managing day-to-day.”
